Feeds:
Posts
Comments

Archive for the ‘Paperwork’ Category

Life as a midwife can be unpredictable but we are always aware on community when it will be busy, just a shame that we can’t be certain which days will be manic and which will just be non-stop. March was a ‘quiet’ month visit wise which was fantastic, we could catch-up with all those add-ons which are mandatory but not time sensitive, however antenatally it was busy. Oodles of pregnant women at the stage of their pregnancy when they start having 2 weekly midwife appointments, if we hadn’t got records showing that a baby boom should be expected in April/May our antenatal clinic’s would alert us to it.

I dread busy clinics, something has to suffer and what I end up minimising is the ‘chat time’. I have to fill in all the paperwork demanded for audit, stats designed by my manager, work timings by the PCT and that’s not even including the woman’s notes and inputting consultation info onto the G.P’s computer. Midwives have been warned that if we fail to submit the bureaucratic paper mountain, ‘stat’, then our pay will be delayed. To me, having the time to sit and talk to my women is often as important as completing their notes, issues we discuss then and any worries they might communicate when they are relaxed can be vital. Having to fill in forms as if they are going out of fashion (wish they would) and hustle women out of the consulting room leaves me feeling as if I am shortchanging the women and not fulfilling my role of being ‘with woman’.

The answer to reducing much of a midwife’s paperwork duplication would be for us to have notebooks or laptops, no, too expensive. Pathetic, shortsighted attitude. All our managers have Blackberry’s, even though they spend the majority of their time in a office, next to a telephone and with their ‘own’ PC in front of them, plus a secretary. Out on community we have 5 chairs in our office, 2 telephones and one PC, most days there are 6 midwives in the office and on some days there also 6 students. Community midwifery has been in existance for 70 years but it operates as if it is a new concept, an add-on which is not considered worth funding, but who does all the initial maternity bookings? Who provides the majority of antenatal and postnatal care? Who is responsible for identifying vulnerable families and liasing with social services and other agencies? Can’t speak for other areas but locally it is the community midwife, the hugely underfunded element of the maternity services where paperwork, even if it has the capability of detracting from patient care is paramount and he area where, when there is a time-saving option which could allow patient care not to be affected, it is dismissed as being too expensive!

Read Full Post »

Looking at the mothering, pregnancy, childbirth forums reveals a fair number of members posting the question ‘I’ve got my first visit with the midwife, what will happen?’. I’m going to answer that now, sort of. My slight hesitation is due to the vagaries of how care is provided, everywhere has slight, in some cases major, differences but the interchange of information between the midwife and the pregnant woman will remain the same.

Differences –

  • In some areas the midwife will be the first port of call
  • In other areas the G.P will be the first contact regarding the pregnancy
  • The ”booking’ may be done at home, at the G.P’s, in a Childrens Centre or at the hospital
  • Weirdly, some hospitals have group booking sessions. No idea how this works, confidentiality and all that, most bookings are the midwife, the woman and any other person she consents to have present

Remember that you are entitled to paid time off work for all appointments associated with your pregnancy.

So, you and the midwife have arranged to meet, you are between 8 – 12 weeks pregnant, expect to spend at least 45 minutes on this meeting. You may have been provided with a pack containing booklets and leaflets prior to the meeting, make sure that you have read them as they may provide you with important information about local maternity units, screening tests, diet etc. The pack may also have a blank copy of your maternity notes, if it does then you can make a start filling them in with your name and other personal details. Having read through the information make a note of any questions you want answers to and also any concerns you may have.

Right, so you meet the midwife. She will have lots of questions for you; your previous medical history; about any previous pregnancies; your close family’s medical history regarding diabetes, high blood pressure, miscarriages, stillbirths and also baby’s born with hereditary conditions, abnormalities some of this will also be about baby’s father. Other questions will be about work, alcohol, smoking, recreational drug use, ethnic origin, contact with Social Services and, obscurely, highest educational qualification. At some point screening for Downs Syndrome will be mentioned. The midwife will ensure that you understand all about the tests available and how to access them if you want the screening.  Some areas arrange these for you and some will provide you with the necessary numbers to call. Screening should be available to all on the NHS, you should not have to pay. The midwife will also explain about the blood tests we feel are necessary during pregnancy, she may ask if she can take the blood at this time. There will also be a discussion about where you would like to have your baby, what facilities are offered and the possibility of using a birth unit or having a home birth.

Having listened to your health and social  history the midwife will assess how your care will be provided, whether at this time you fall into the group classed by the hospital as low-risk or whether you need to be seen by an obstetrician. Whichever group you fall into, by the time the midwife leaves you should know the plan for your care and where and when you need to be seen during your pregnancy. At this early time it is difficult to be exact, the midwife can only guesstimate to within 2-3 week windows when the scans will be, and who knows when the consultant appointment will be if you need to see them but she will write down the weeks of pregnancy when you need to be receiving antenatal care and how the appointments are made for these. Information will also be given about the local provision for parentcraft/antenatal classes and contact details given for accessing them. You will also be given the contact details for your midwife and/or her team plus all the local maternity unit numbers.Other topics will include your employment rights during pregnancy, diet, exercise, domestic violence and smoking cessation, you will also receive your form which entitles you to free prescriptions during the pregnancy and until baby is 1 year old. Data protection will be highlighted and the fact it has been discussed will be recorded. I do not discuss labour at this point if it is the first baby but I do cover it following attendance at parentcraft classes and as the end of pregnancy approaches but some midwives may talk about it at this time.

The midwife may test your urine at this time and in some areas a urine specimen will be sent off to be screened for underlying infection. Your blood pressure will also be recorded, along with your weight and height and your BMI calculated. Listening to baby’s heart? Highly unlikely before 12 weeks as baby is still very small and is hidden down below the pubic bone.

By the end of this you may well be suffering from information overload but don’t worry as the midwife will have written everything down in your notes and/or left you leaflets about different topics so you can recap at your leisure!

Here is a link to the NICE Guidelines on Antenatal Care which provide the basis on which your care will be organised.

Read Full Post »

I’m in a sulk. I received an ‘invitation’ to register for a conference today, HSJ Maternity Services Conference 2010 , I clicked on the link and was really interested in the agenda, especially as there was much in there which pertained to community midwifery, both the practice and the funding. I checked the date, yes, I would be fit to attend, Tuesday, not ideal as it’s a clinic day but there is enough time for me to rearrange that clinic, so I clicked on the delegate rates. Now, much as I love conferences and know that I would get a great deal from this one, £399 ( £430 with travel etc) is way out of my price range and, for me, a mega amount of money to spend on a ONE day conference so I shall not be attending and I doubt that any other ‘grass roots’ midwives will either. I would hazard a guess that if I cared to attempt a chat with any midwifery managers that day they would be thin on the ground. They will all be there, in London, chummy, chummy, huddling together and nodding wisely as other managers powerpoint away telling them how to impose more paperwork on clinicians whilst reducing patient contact. Sorry, there is the ‘token’ speaker from a users group, the NCT, she will explain how women are unhappy with the care they receive and what the maternity services need to do to improve the situation. The women are unhappy, well I am as well but it ain’t going to get any better, ever. With reduced budgets, increased workloads and increased paperwork there is no way the service can do anything other than reduce and reduce. If you look at the programme it just about says it all, ‘collecting data; analyzing; compliance monitoring; monitoring improvements; engaging the workforce to gather and report timely information; measuring quality’ of yes, there’s a lot of information gathering going on here and who will do it? The midwives. First though there will have to be lots of nice meetings, brain-stormings and oodles of consultations, I should think a few management companies are rubbing their hands at this point anticipating the studies which will be initiated and the revenue these will generate.

I want to be there, I want to be able to hear rationales, I want to debate and comment on change and, more importantly, is it cost-effective and will it improve outcomes? Personally I’m fed-up with having initiatives  thrust upon us from some faceless echelon which magics up ideas and then expects the workforce to implement, audit and document ad nauseum. In a previous post I recorded a days work and compared the time spent on patient contact with other tasks, and now I find that The Nursing Times has discovered that community midwives spend 40% of their time on paperwork and travelling. and they had to conduct research (wonder how much that cost) to come up with that revelation. Well, now its official will someone please take notice and reduce the repetition and the gathering and recording we have to do. Yes, talk about it at the conference but not as to how midwives can record data but as to how systems can be introduced which will cut down on the repetition and free up midiwives to do the job they were trained for.

Read Full Post »

 

Back in the middle of 2009 I was referred by my G.P to a London teaching hospital. After many trials and tribulations I finally saw the consultant, the decision was made to schedule surgery, the exact nature of which would be based upon the results of further scans and tests. I fairly bounced my way home, at last I could look forward to resolution.

I’ve spent the 2 years, since my previous surgery, in discomfort and, by the end of the day, in pain. I’ve put up with it and carried on regardless but increasingly it has been affecting more and more of my day-to-day life. As long as I believed that my op would be only a few weeks away I was prepared to ‘grin an bear it’ but last week my gritty determination crumbled. I had the tests and scans back in December, I had a further appointment last week where. after a 2 hour wait, I was called in. The doc, not the consultant, duly reviewed my scans and told me the plan, fairly simple operation with a reasonable recovery time, yeah! ‘When, when?’ I grinned and, after a brief discussion with the nurses, he told me, ‘ Probably June’.

I slouched home and then spent 10 minutes blubbing. How I wish that the hands of the clock did rotate at a visually disturbing rate, I just want things sorted soon, quickly. In 2 words the doc had made my symptoms escalate from bearable to unbearable. By the evening I’m really tired and extremely uncomfortable, on-calls are now more stressful. It’s not just my usual disinclination to get up in the middle of the night and drive to a previously unknown destination for an unspecified length of time but also a fear that I may not function at 100% when I get there. I mulled the situation over and decided to go and have a chat with the occupational health department. Dream on, what occupational health department, they have been re-branded, Workplace Health. No longer are they there solely for NHS employees, no, workplace health (WPH) are there for NHS, plus they are also providers to the public and businesses. I found this out when I misguidedly phoned them to arrange an appointment, another faux paux as there are no direct referrals, my manager has to refer me. I am now firmly off  into the land of Alice, for years I have inhabited a workplace where, if you had a work-related health query you would chat about it to occy health, you certainly didn’t have to spread word of your personal, health problems around. Right, in Wonderland I have to go to my manager, tell her what ails me and let her decide if I do need to see them. Manager then has to do a referral and then Workplace Health will triage (their word, not mine) me and arrange an appointment accordingly. I’ve done it all, I even made sure that HR were there when I spoke to my manager, I’m really dotting i’s and crossing t’s nowadays, I’m losing faith in people’s motives. HR advised me to phone WPH a week later if I hadn’t heard anything as she felt that I should see them sooner rather than later but I’m generous, I left it 10 days before I phoned them. They cannot find my referral, I have 2 copies, 1 sent by email and the other by snail mail but they haven’t received it in any form, not even by pigeon post. No referral, so no appointment. WPH want a new referral, I’ve sent them one of my copies.

It’s really difficult not to become extremely frustrated by all this paper-trailing, waiting and black holes that referrals disappear into. I can’t believe that I am unlucky enough to have this only happen to me, twice. I don’t expect an instant service, I know that the hands of the clock move slowly within the NHS, but I do expect that once paperwork has been sent that people can at least find it and that when they can’t they at least take ownership of the problem, not turn the poor unfortunate person who has been referred into a human ball being bounced backwards and forwards.

Read Full Post »

Whiskey talking

We’ve been told that there will be redundancies, ‘not clinical’ they hastened to add. No, it will be our clerks, those helpful souls who co-ordinate, organise and generally help pull together all the threads within the megastructure which is the NHS. My first reaction was disappointment for myself, I was hoping that I would be made redundant but then the real blow registered, if a clerk isn’t doing the paperwork who will be? Well, it won’t be the managers, unless the paperwork involves ensuring the issuing of an overwhelming number of memo’s, so I have to assume that the tasks are going to be headed toward clinicians. This has been gradually sinking in throughout the day and I am now resorting to alcohol to soften my musings, as earlier I gave in to misery and contemplated different ways in which I could stop being a hamster on a wheel.

Why am I so depressed? Well…….I had planned to retire next year but unfortunately Hubby’s pension is one of the ones that has virtually disappeared over the past few years so I’m sentenced to continue working for at least another 3 years. Why had I wanted to retire, after all I had wanted to be a midwife since I was 17, I used to love the job. Well……midwifery ain’t what it was. The work has become increasingly stressful, the paperwork has increased 5-fold, the goalposts are being moved every other week and the support and appreciation from managers has vanished. This week has been a normal workload, there is not a bulge in my caseload this month (next month is a different matter), so you would imagine that I could have completed all my work related tasks within my contracted working hours. I couldn’t and I didn’t. On 2 of the days I finished 90 minutes late, that’s 3 hours over, one late day was due to having a student out with me who needed her assessment documents completed, the other was because a colleague had to attend a mandatory study session so I had to pick up her visits. On my day off I then spent 3 hours, in the office, trying to organise care for a woman who had presented at 28 weeks pregnant, unbooked and requesting her care be at a hospital outside our area and also completing a social services referral for the unborn child of another woman who has failed to attend 4 antenatal appointments and whose other children are already considered to be ‘at risk’. Both tasks are too important to leave until my next working day and they have to be done by the named midwife.

Now, if in one week I can succeed in spending 6 hours of my own time on work related tasks, I won’t be paid for extra hours, when I have the present level of clerical support, then how much of my own time, how much of my relaxation time am I going to be donating when these ‘savage cuts’ are implemented?

Read Full Post »

All the airlines seem to have different ideas about pregnant women and flying. If one of my women tells me that she is about to depart for foreign climes via an airline, and she is 28 – 34 weeks pregnant, I make sure that she has a letter from me informing ‘whom it may concern’ that, at the time I examined her, I could see no reason to doubt her fitness to be transported by airplane. The G.Ps charge £15 for the same letter, I just do it, I don’t think that I can make a charge.

On Friday I saw someone who had just returned from Portugal. Before she went she asked me for a F2F letter, unfortunately her flight was 8 days away and the airline she was flying with demand that the examination be within 5 days of flying, so I couldn’t issue it and the G.P (earned)gained £15. That wasn’t the end of the ‘taxes’ for flying when pregnant, oh no, the ‘low cost’ airline have got a particularly wonderful little wheeze for the unsuspecting, pregnant traveller, you need another F2F to get back from your holiday, even if it was only for 1 week. Apparently, when you try to check-in for the return journey, they ask for your letter, observe that it was signed over 5 days before, and send you to a local doc. The local doc is jolly thorough, far more than the old G.P or midwife back in blighty, not only does he check blood pressure and urine, he also does a scan. Wonderful service, if totally unnecessary. Oh yes, but it comes at a cost, €96. The local doc must love it, wonder how he got the airline to recommend him, was it Easy?

Having heard this story I decided to see if this is now common practice amongst the airlines, do they all demand a certificate/letter signed within 5 days of flying?

Ryanair –  Once your pregnancy has entered its 28th week, we ask that you carry with you a letter from your obstetrician stating the pregnancy is uncomplicated and confirming the expected date of delivery. In this letter, the doctor should state that you are in good health, that he/she is happy for you to fly, and that in his/her opinion there is no reason why you cannot fly. No timescale for signing here but the stipulation of ‘obstetrician’ may cause problems for women having midwife-led care.

Quantas Medical clearance is only required if you are having complications of pregnancy. International travel is not permitted after the 36th week for routine pregnancies or the 32nd week for routine multiple pregnancies. Very laid-back, dare I say ‘sensible’ attitude!

Flybe – Between 28 and the end of 33 weeks, we require a doctor’s note certifying fitness for air travel. No time specification.

Monarch – If you are 28-34 weeks pregnant, you will need to carry with you a doctor or midwifes certificate of fitness to fly. The certificate will only be accepted if:

  • It is dated not more than 14 days prior to the start date of your trip.
  • It states the expected date of delivery of your baby.
  • Your doctor or midwife states that you are in good health, that they are happy for you to fly, and that (in their opinion) there is no reason why you cannot fly.

(Yeah, ‘midwife’)

BAAfter your pregnancy has entered its 28th week, we ask that you carry with you a letter from your doctor or midwife, stating the pregnancy is uncomplicated and confirming the expected date of delivery. In this letter, your doctor should state that you are in good health, that they are happy for you to fly, and that (in their opinion) there is no reason why you cannot fly.

Checked other airlines and they all, so far, do not have the 5 day rule of  the budget airline.

My advise to any woman travelling after 28 weeks of pregnancy and intending on not returning for 5+days, is to add £100 to the cost of flights as quoted by ‘Europe’s leading low-cost airline’ to allow for satisfying their F2F demands.

I have attempted to contact the company involved by email, I have discovered that this is impossible. I could phone their customer services but I really don’t want to throw more money at them. So, if  anyone from the company in question would like to comment on their policy and why no other airline has the 5 day rule and why an unnecessary scan is performed, I would really love it.

Read Full Post »

grit

Friday morning was a full clinic, plus one extra. It would have been an excellent clinic for a student to be involved in as it covered many different aspects of a midwife’s role in antenatal care. There were early pregnancies, where the women who have been pregnant before were laid back but those who are in their first pregnancy were anxious +++ and in need of lots of reassurance. Then there was a woman who has a rhesus negative blood group so requires anti-D; the woman who arrived with a list of questions, concerns and different options for pushchairs; the woman who had HELLP in her previous pregnancy and decided to cancel her appointment with the consultant obstetrician and see me instead and 2 women with pregnancy related social concerns, 1 housing and 1 employment. Somewhere along the line midwives have been assimilated into benefit administration, I’m talking here about the Health in Pregnancy Grant. This new benefit is available to all women from the 25th week of their pregnancy and is worth £190. The form needs to be completed by a doctor or midwife, unfortunately the G.P’s at my surgery are unable to fill in forms, unless they can charge for it, so this little task falls to me, another bit a paperwork which eats into time I could spend on clinical tasks and giving advice or providing support. Since I consider midwifery per se to be as important, if not more important than form filling, and more likely to assist with health in pregnancy, the appointments take longer and my clinic runs later, and later. Luckily all the women attending on Friday were, if not happy with the wait, not annoyed either.

Clinic finished at 1.30 pm and then my visits started. It should all have been so simple but my destiny was obviously not to finish on time but rather to encounter delays. First was the Mum and baby who were due to be discharged, the problem there was Grandmother. I needed to weigh baby prior to discharge but the ferocious maternal grandmother was not about to relinquish control of baby. She decided that baby was hungry and that she was going to give baby a bottle before I weighed her. I said that I would like to weigh baby before she fed it, she said I would have to wait, I explained that it would be best if I could put baby on the scales first, her response was that it would be best if baby had it’s milk first. As she started giving baby a bottle it’s Daddy intervened and told her to stop feeding baby and either get her undressed or give her to me for me to do it. Grandmother decided to undress baby, in slow-mo. Gritted teeth.

During clinic I had received a phonecall re a woman with breastfeeding issues requiring a visit. I had visited on Tuesday when it was identified that she had inverted nipples. Obviously this can make breastfeeding problematic but we discussed strategies to encourage her nipples to come out and she had said that she would be going to the breastfeeding clinic, she hadn’t gone, the strategies weren’t working and she was distressed. Baby was inconsistent with latching on to the breast, one of her nipples was very sore and she had been offering expressed breast milk via a tea-spoon. After a quick check of baby to make sure that she was well hydrated and not unwell we set about solving all the issues. Nipple shields were thoroughly washed, Lansinoh was applied to the nipples, Mum was made comfortable and baby was put to the breast by Mum. Immediately a couple of potential problems were obvious; Mum was bringing her shoulder forward as baby was latching on. This alters the angle of baby’s mouth to the nipple making the baby take less areola so making baby suck solely on the nipple. (There is a good picture on the Medela site which demonstrates the poor positioning really well). It also causes the woman to develop shoulder, neck pain as she adopts a stooped position. Once we had sorted out the positioning K reported that it felt more comfortable and baby, rather than fighting the breast and repeatedly pulling, back suckled well for 20 minutes.

By now it was 3.15pm and I had a booking appointment to do 5 miles away but I still had a Day 5 postnatal visit to do. I phoned H who I would be booking and explained that I was running late but that I anticipated being with her by 4pm. A day 5 visit is the Newborn bloodspot screening and first weigh after the birth, plus any other issues which may be identified. Hmmm. Interesting couple who I was aware had been a little demanding during the pregnancy. I had seen them twice before and had not encountered any ‘problems’ so expected a half hour visit. The first minor detour was a request to take baby’s temperature, when I queried the rationale I was told that they wished a ‘professional’ estimation. Bearing in mind the issues my colleagues had encountered I complied, it was entirely normal. Eventually I had finished all my clinical activities and was getting ready to leave when the husband stopped me in my tracks by saying that they were going to be putting an official complaint about one of my colleagues. I sat back down and asked him to tell me why they were dissatisfied with the care she had given them. Half an hour later I had discovered that they had no issues with her clinically but they felt that she was not respectful of their time as she had arrived late once and her clinics always ran late and, that when they had told her they were disatisfied, she had not appeared to take it seriously enough. There were also issues with the time she had, apparently, taken to process some paperwork. I attempted to explain to them the difficulties midwives experience with time-keeping, this did not wash, they, or rather he, were on a roll and were not about accept any other perspective than his own. I let him into a few facts about lack of fax machines, hospital postal services etc., apparently midwives should provide their own fax machines and deliver all correspondance by hand. (Brick wall and head). Eventually I managed to find an appropriate time to take my leave, telling them, through gritted teeth, that I would be back on Monday.

I finally manged o get to my booking apointment with H at 4.45, an hour and a quarter late. How did she greet me? Was she annoyed that I had not shown consideration for her time? No. She opened the door, identified that I was running late and was probably in dire need of a coffee and she set about making me a drink. Yes, midwives are human!

I finished work at 6pm. I had had a 15 minute break since I started at 8.30am and had a bruised jaw from repeated gritted teeth.

Read Full Post »

Older Posts »